Consumers will have more responsibilities under health care reform

BREMERTON - Twenty folks from around Kitsap bit the bullet Sunday, trading a pleasant day outdoors for one spent in a dark conference room enduring a presentation on what health care reform will mean for them.

The take-away for this stalwart bunch was that consumers — not their doctors, hospital or insurers — will be in charge when it comes to decisions about their care. That care will be focused on wellness and prevention, and not on curing them once they get sick. Reform's hoped-for outcome will be healthier people and a less expensive health care system.

"You've got to take responsibility for your care," said Michelle Vest, a reform consultant who led the presentation at the Norm Dicks Government Center sponsored by the Kitsap Public Health District and reform-education group called Organizing for Action.

First the nuts and bolts:

The goal under reform is to get everyone insured. To help make that happen, the Washington Health Benefit Exchange will introduce an insurance marketplace, Washington Health Plan Finder, starting Oct. 1.

Those without insurance have until March 31 to sign up for some or pay penalties.

Currently, four insurance companies offering 31 plans are approved for residents of Kitsap County. They are Group Health Cooperative, Premera Blue Cross, Bridgespan and LifeWise. The penalties go up to 2.5 percent of consumers' incomes by 2016.

Consumers who now buy their own insurance might pay less. Young people might pay more; older people less.

Besides requiring insurance for all, reform will change how care is delivered.

Consumers might have gotten calls from their primary care doctors telling them it's time for their annual exam, Vest said. The idea is to catch illness or illness-causing habits early before they become big, expensive problems. That's a challenge, Vest said, because medical schools train doctors to cure illness rather than promote wellness, though that is changing.

"In the old world, he or she only got paid if you got sick. Now they're paid if you stay well," Vest said.

Like never before, primary care doctors will be sharing consumers' information with specialists, cutting down on duplicative tests.

"So everybody knows what you're about," Vest said.

Doctors will suggest what options to take, but it will be consumers making the choices. The options doctors lay out must be backed by research that proves they have the best chance at good results.

"They're not trying something just for the heck of it," she said.

As far as medications, doctors will at first prescribe less expensive ones; if they don't work, prescriptions gradually will step up to more expensive drugs.

Outpatient services currently offered in expensive hospital settings increasingly will be offered in less expensive settings, like doctors' offices.

A wider array of people will help consumers walk along their wellness and prevention paths. Some might drive them to appointments. Coaches might phone to encourage consumers to stick to a certain regimen.

Reform has no effect on consumers under Medicare. The same holds true for those receiving Veterans Affairs benefits, and for Tricare and Tricare for Life policyholders.

Vest agreed with audience members who said it was difficult to convince their young-adult children to buy insurance at all. She responded it would be better for them to buy catastrophic coverage with a high deductible than to pay the penalty.

"We can't afford to continue what we're doing," Vest said, noting that U.S. per capita spend on health care is the highest in the world.